Virtual Case Management Services in Texas

UnitedHealthcare Community Plan of Texas implemented virtual case management (VCM) in April 2020 allowing service coordinators to facilitate virtual visits with members using telehealth technology. Service coordinators have been able to leverage VCM to stay connected with members, complete assessments and ensure members are getting the care they need when they need it. Currently, about 200 service coordinators use VCM to meet member’s needs on day-to-day basis.

VCM services have been especially important for service coordinators completing assessments for members with disabilities and chronic conditions – individuals who are more likely to be in the high-risk category for COVID-19. Historically, these individuals would meet with a service coordinator in-person to be assessed on an annual basis or whenever a change in their condition dictated a change in their service plan. The ability to leverage VCM ensures that individuals continue to have access to safe and timely care.

For one member, VCM changed the way he has been able to care for his chronic condition. Mr. Reyes*, whose conditions include diabetes and hypertension, was connected to Betty, a Complex Care Service Coordinator at UnitedHealthcare Community Plan of Texas. Betty did an initial assessment to learn more about Mr. Reyes’ needs and health and learned that he had been checking his blood sugar incorrectly and was unable to monitor his blood pressure all together. Betty ordered a glucose monitor and blood pressure machine so Mr. Reyes could learn to monitor his numbers and participate in his care at home. Betty also taught Mr. Reyes the importance of checking his blood pressure one hour before and after taking his prescribed blood pressure medication to ensure it was helping him manage his condition effectively.

Mr. Reyes began connecting with Betty regularly through virtual visits. The virtual format made it easier for Mr. Reyes to stay engaged and increased his willingness to work with her; through their visits she was ultimately able to:

Assess symptoms when he believed he needed to visit the ER – the member shared that he had been dizzy but didn’t know what to do since it was after office hours. Betty coordinated an immediate telehealth visit with a physician who assessed Mr. Reyes virtually.

Work with Mr. Reyes and his family to help them obtain COVID-19 testing when they began experiencing symptoms.

Support the family with food delivery, formula and diapers after they tested positive for COVID-19 and were unable to access supplies due to quarantine requirements.

Provide enough education about his conditions that he began to feel comfortable enough to monitor his numbers on his own.

VCM allows service coordinators to provide members with continuous support in a setting where many are most comfortable – their homes. By connecting with members virtually, service coordinators can connect more frequently while delivering the same individualized care. VCM has proven to be an effective platform that keeps both members and their care teams safe.

One service coordinator expressed how easy VCM has made it to treat members in a timely way sharing,

“One of my member’s was experiencing liver failure, but he was required to have dental work before he could be placed on a transplant list. With access to telehealth capabilities I was able to move this individual through the process and appointments quickly which was critical because in his case it meant life or death.”

UnitedHealthcare Community Plan of Texas will continue to deploy innovative solutions to meet the needs of our members and the communities we serve.

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